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Telehealth Reimbursement

OIG Expands Telehealth, Telemedicine Audits to Medicaid Claims

November 21, 2017 - Healthcare providers will be checking to make sure their telehealth and telemedicine programs comply with state Medicaid regulations following news that the Health and Human Services Department’s Office of the Inspector General will be launching an audit. The OIG made the announcement this week that it would be reviewing state Medicaid payments for telemedicine and other remote services...


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MA Telehealth Bill Set For Passage; Others Aren’t So Fortunate

by Eric Wicklund

A proposed bill to boost telehealth coverage in Medicare Advantage plans is set for passage, while other bills that would loosen Medicare’s restrictions on telemedicine and telehealth – including expanding telestroke services –...

CMS Won’t Cover Telehealth in Medicare Diabetes Prevention Program

by Eric Wicklund

The Centers for Medicare and Medicaid Services has once again declined to cover virtual coaching platforms in the Medicare Diabetes Prevention Program, saying the mHealth and telehealth platform isn’t reliable enough to warrant reimbursement....

Kansas Payers Push Back Against Telehealth Payment Parity

by Eric Wicklund

Payers in Kansas are fighting proposals for payment parity in telehealth, saying a virtual visit shouldn’t be reimbursed at the same rate as in in-person visit. “Telemedicine services are not equivalent to in-person services and,...

Telehealth Barriers Should Be Defined by Access, Not Geography

by Eric Wicklund

Telehealth and telemedicine programs aren’t catching on in urban America because reimbursement models are targeting the wrong metric. That’s the opinion of researchers from Princeton University and Philadelphia’s Thomas Jefferson...

Congress Mulls Proposal to Boost Telehealth Coverage in MA Plans

by Eric Wicklund

The latest telehealth bill surfacing in Washington DC targets Medicare Advantage plans. H.R. 3727, introduced on Sept. 11 by US Reps. Diane Black (R-Tenn.), Mike Thompson (D-Calif.), Doris Matsui (D-Calif..) and Susan Brooks (R-Ind.), would enable...

Medicare Spending on Telehealth Increases, But Barriers Remain

by Eric Wicklund

Healthcare providers may be using more telehealth and telemedicine than ever before, but Medicare Is still a significant barrier to growth. An analysis of the Centers for Medicare and Medicare Services’ 2016 payments for telehealth and...

CMS Reimbursing For Telemedicine Even As It Scales Back Programs

by Eric Wicklund

In a bit of good news-bad news for the telemedicine industry, federal officials said they will reimburse healthcare providers for their telemedicine expenses in a bundled payment program – even as they announced plans to scale back that...

Telehealth Stands to Gain from Anthem’s ER Policy Expansion

by Eric Wicklund

Anthem is expanding its strategy of denying payments for unnecessary ER visits, a move that could push more consumers across the country toward telehealth or mHealth services. The insurer, which administers Blue Cross Blue Shield plans in 14...

CMS Urged to Include mHealth in Diabetes Prevention Program

by Eric Wicklund

Digital diabetes coaching providers are joining forces in an effort to convince the Centers for Medicare and Medicaid Services to include mHealth in the Medicare Diabetes Prevention Program. Some virtual coaching is included in the MDPP, which...

New Bill Seeks to Expand Medicare Reimbursement for Telemedicine

by Eric Wicklund

A bill to expand Medicare coverage for telehealth services that has been kicked around on Capitol Hill since 2013 is once again in Congress’ hands. U.S. Rep. Gregg Harper (R-Miss.) has re-introduced the Telehealth Enhancement Act (H.R....

CMS Considers Telehealth for New Models of Behavioral Healthcare

by Eric Wicklund

Federal officials are looking at telehealth in their search for new models of care for Medicare and Medicaid beneficiaries with behavioral health issues. The Centers for Medicare & Medicaid Services has scheduled a September summit to develop...

Feds to Probe Improper Telehealth Reimbursements Under Medicare

by Eric Wicklund

Federal officials are investigating whether physicians are receiving improper reimbursements for telehealth under Medicare Part B guidelines. The Health and Human Services Department’s Office of the Inspector General (OIG) will be checking...

PA Legislature Introduces Telemedicine Reimbursement Bill

by Thomas Beaton

Pennsylvania has opened the door to becoming the next state to allow full telemedicine reimbursement parity for care services. Senator Elder Vogel (R-Beaver) introduced Senate Bill 780 to define key components of telemedicine, set telemedicine...

Ga. Payer Pushes Telehealth to Replace Unnecessary ER Visits

by Eric Wicklund

A Georgia insurer is taking strong steps to promote telehealth as a replacement for most emergency room visits. Starting in July, Blue Cross Blue Shield of Georgia will stop reimbursing for ER visits deemed to be unnecessary. The payer is recommending...

VT Legislature Approves Telemedicine Reimbursement Bill

by Thomas Beaton

UPDATE: Govenor Phil Scott (R.) signed S.50 into law, requiring insurance companies to pay providers the same rates for telemedicine usage as an in-person visit. The bill goes into effect on October 1, 2017.  Legislation that has...

EHR Integration, Analytics Lead Hospitals to Enterprise Telehealth

by Thomas Beaton

Telehealth and telemedicine for many hospitals is moving from a departmental approach to a more centralized method that allows hospitals to capitalize on EHR integration and analytics-driven decision making. A new report from REACH Health found...

Examining the State of Medicaid Telehealth Reimbursement

by Thomas Beaton

The majority of the United States offers Medicaid reimbursement for telehealth and related services, but reimbursement rules within each state can vary significantly, according to the Center for Connected Health Policy (CCHP).   CCHP's...

Providers Must Negotiate Telehealth Reimbursement With Payers

by Eric Wicklund

Healthcare providers looking to launch a new telemedicine or mHealth program may find an unexpected ally in commercial health plans. While only 31 states and the District of Colombia mandate that private payers cover telehealth visits as they...

GAO Report: Telehealth Troubles Tied to Reimbursement Barriers

by Eric Wicklund

Healthcare providers aren’t embracing telehealth and remote patient monitoring because they aren’t being reimbursed for those services, according to a new report from the U.S. Government Accountability Office. The GAO report, issued...

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